Kyle Jervis, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

7195 Issued in AZ

Practice address

13677 W McDowell Rd # Az85395
Goodyear, AZ 85395-2635

Phone

(623) 882-1500

NPI assigned

Apr 21, 2017

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AZ

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Interoperability endpoints

• Direct secure messaging: kjervis416187@direct.hopkinsmedicine.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Arizona Acute Medical Services 1 PC

  • Hospitalist Physician
  • Phoenix, AZ
  • NPI 1154860674
  Medicare reassignment
• Emergency Group of Arizona Professional Corporation

  • Emergency Medicine Physician
  • Phoenix, AZ
  • NPI 1215275433
  Medicare reassignment
• Tec Emergency Physicians of Arizona, LLC

  • Emergency Care Clinic/Center
  • Gilbert, AZ
  • NPI 1245772870
  Medicare reassignment
• Frederick Health Hospital Inc

  • General Acute Care Hospital
  • Frederick, MD
  • NPI 1538165527
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492732800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1686268800000",
    "number": "1053846659",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "19947 W RANCHO DR",
            "city": "LITCHFIELD PARK",
            "state": "AZ",
            "postal_code": "853402667",
            "telephone_number": "602-740-0131"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13677 W MCDOWELL RD # AZ85395",
            "city": "GOODYEAR",
            "state": "AZ",
            "postal_code": "853952635",
            "telephone_number": "623-882-1500"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "JERVIS",
        "first_name": "KYLE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-21",
        "last_updated": "2023-06-09",
        "certification_date": "2023-06-09",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "AZ",
            "license": "7195",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "MD",
            "license": "C06468",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Patrick Jennings, PT, DPT
• David Laurtiz Jensen, D.O.
• Samuel Jensen
• Jerome a Cohn DPM PC
• Jerome a Cohn, DPM, PC
• Kaitlin Suzanne Jeter, LAMFT
• Taylor Jezuit, PT, DPT
• Holly Ann Jimmerson, SLPA
• Robin Jin
• Analyn Magpantay Joens, MOTR/L

• Physician Assistant in Goodyear, AZ
• Providers in Goodyear, AZ by specialty
• Physician Assistant in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 9, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.